A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

Correct Answer: A

Rationale: The correct answer is A: Helicobacterial infection. This is the most probable leading mechanism of disease development in this case because the patient's symptoms, such as heartburn, epigastric pain, food intolerance, and presence of a duodenal ulcer with a positive urease test, are classic signs of Helicobacter pylori infection. This bacterium colonizes the stomach lining, leading to inflammation and ulcer formation. The exacerbations in spring and autumn could be due to seasonal variations in immune response. Choice B: Dietary allergy is incorrect because the symptoms and findings in the patient are more indicative of an infectious etiology rather than an allergic reaction to specific foods. Choice C: Autoantibody production is unlikely as there are no indications of an autoimmune process in this case. Choice D: Reduced prostaglandin synthesis is not the leading mechanism as the symptoms and findings are more consistent with an infectious cause rather than a deficiency in prostaglandin synthesis.

Correct Answer: A

Rationale: The correct answer is A: Helicobacterial infection. This is the most probable leading mechanism of disease development in this case because the patient's symptoms, such as heartburn, epigastric pain, food intolerance, and presence of a duodenal ulcer with a positive urease test, are classic signs of Helicobacter pylori infection. This bacterium colonizes the stomach lining, leading to inflammation and ulcer formation. The exacerbations in spring and autumn could be due to seasonal variations in immune response. Choice B: Dietary allergy is incorrect because the symptoms and findings in the patient are more indicative of an infectious etiology rather than an allergic reaction to specific foods. Choice C: Autoantibody production is unlikely as there are no indications of an autoimmune process in this case. Choice D: Reduced prostaglandin synthesis is not the leading mechanism as the symptoms and findings are more consistent with an infectious cause rather than a deficiency in prostaglandin synthesis.

Correct Answer: A

Rationale: The correct answer is A: Tuberculin. In this clinical scenario, the patient presents with symptoms suggestive of tuberculosis, including chronic cough, night sweats, weight loss, and hemoptysis. The Mantoux test, also known as the tuberculin skin test, is used to screen for tuberculosis. Tuberculin, a purified protein derivative (PPD) derived from Mycobacterium tuberculosis, is injected intradermally. The test elicits a delayed-type hypersensitivity reaction in individuals who have been exposed to the organism in the past. A positive Mantoux test indicates exposure to tuberculosis and does not differentiate between active infection and prior exposure. Explanation for other choices: B: Measles - Measles is a viral infection that presents with a characteristic rash and fever, not consistent with the symptoms described in the case. C: Tetanus and diphtheria toxoids vaccine (Td) - Td vaccine is not used for tuberculosis screening and does not elicit

Correct Answer: B

Rationale: The correct answer is B: Mycobacterium leprae. This bacterium is responsible for causing leprosy, also known as Hansen's disease. Mycobacterium leprae specifically targets the skin, peripheral nerves, and mucosa of the upper respiratory tract. It is an acid-fast bacterium with a slow growth rate, making it difficult to culture in the laboratory. Streptococcus pyogenes (choice A) is responsible for various infections such as strep throat, Neisseria gonorrhoeae (choice C) causes gonorrhea, and Escherichia coli (choice D) is commonly found in the gut and can lead to various infections but not leprosy.

Correct Answer: C

Rationale: The correct answer is C: IFA - Immunofluorescence assay. Toxoplasmosis and chronic gonorrhea can be detected using serological tests like IFA. IFA detects specific antibodies in the patient's serum by using fluorescently labeled antibodies. This method is highly sensitive and specific for detecting both acute and latent infections. Explanation of Incorrect Choices: A: RIHA - Reverse indirect hemagglutination assay - This test is not commonly used for detecting toxoplasmosis or chronic gonorrhea. B: RDHA - Reverse direct hemagglutination assay - This test is not typically used for these specific infections. D: Immunoblot analysis - While Immunoblot analysis is a useful confirmatory test for certain infections, it is not the primary method for detecting toxoplasmosis or chronic gonorrhea.

Correct Answer: C

Rationale: Rationale: Choice C is correct because immunomodulators can indeed be natural (e.g., cytokines) or artificial compounds (e.g., synthetic peptides). They work by modulating the immune response, enhancing or suppressing it as needed. Choice A is incorrect because immunomodulators can stimulate both humoral and cellular immune responses. Choice B is incorrect as isoniazid is primarily an antibiotic used to treat tuberculosis, not an immunomodulator. Choice D is incorrect because immunomodulators can have varying effects on the immune response, not just suppress it.

Correct Answer: C

Rationale: Rationale: 1. Bacillus anthracis is a spore-forming bacterium that can survive for decades in the soil. 2. The spores are resistant to harsh conditions and can remain dormant for long periods. 3. This resilience allows Bacillus anthracis to persist in the old cattle burial ground for over 50 years. 4. Mycobacterium bovis, Brucella abortus, and Francisella tularensis are not known for long-term survival in soil. Summary: - Mycobacterium bovis, Brucella abortus, and Francisella tularensis do not have the spore-forming ability. - Mycobacterium bovis causes tuberculosis in cattle. - Brucella abortus causes brucellosis in cattle. - Francisella tularensis causes tularemia in animals and humans.

Correct Answer: A

Rationale: The correct answer is A: Pseudomonas aeruginosa. P. aeruginosa is known for producing a blue-green pigment called pyocyanin, which gives a characteristic color to the colonies. The fruity odor is due to the production of a compound called 2-aminoacetophenone by P. aeruginosa. These features are classic for P. aeruginosa and help differentiate it from other Gram-negative rods. Proteus mirabilis (B) typically does not produce blue-green pigment or fruity odor. Klebsiella pneumoniae (C) and Escherichia coli (D) also do not exhibit these specific characteristics associated with P. aeruginosa.

Correct Answer: A

Rationale: The correct answer is A: Fluconazole. 1. Fluconazole is an antifungal agent effective against Candida species commonly causing candidiasis. 2. Streptomycin (B) is an antibiotic used for bacterial infections, not fungal. 3. Phthalylsulfathiazole (C) is an antibacterial agent, not antifungal. 4. Ampicillin (D) is a β-lactam antibiotic, which can actually contribute to fungal infections like candidiasis.